Spinal stabilization without implantation of hardware into the vertebrae proper or violation of cortical bone

ABSTRACT

A device and method for use which stabilizes a target motion segment of the spine without the use of screws or any form of hardware implanted into the vertebrae. By being comprised of modular segments and assembled onto the target motion segment at the time of implantation, it can be provided in kit form designed for each patient. The stabilization apparatus general comprises elements; one is adjustably secured to the posterolateral aspect of the caudal vertebra of the target motion segment, with another element being secured to the base of the spinous process of the cranial vertebra of the target motion segment. These two elements are then coupled to each other by either an elongated rod-like connecting element, or extensions from the two anchoring elements which then couple.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to and is a continuation ofinternational patent application PCT/US16/13030 (filed Jan. 12, 2016)which claims priority to non-provisional of U.S. Patent Application Ser.No. 62/102,581 (filed Jan. 12, 2015), the entirety of which isincorporated herein by reference.

BACKGROUND OF THE INVENTION

There are many causes for back pain, including systemic disorders,tumors, and infections, but by far the most common cause is degenerativedisease. This disease process is especially prominent in the lowerlumbar spine, most commonly affecting the L4-L5 and L5-S1 levels.

A recent study from the American Chiropractic Society demonstrates thaton average, 31 million Americans seek help for back pain annually. Thisnumber is growing for a number of reasons including, tobacco use, theincreasing participation of Americans in contact sports and physicalactivity as well as the advancing age of American society. The vastmajority of these patients are easily treated with conservativemanagement such as Chiropractic adjustment, physical therapy, Massagetherapy, and other techniques. However, a subset of patients with backpain will not respond to this type of treatment and are referred forsurgical evaluation.

Much is yet to be learned in terms of the physiology and pathophysiologyof the spine, and at present, a well-accepted paradigm is the so-calledspinal motion segment. This refers to any particular pair of adjacentvertebrae along with the intervening disc and associated muscles,tendons, ligaments, and neurovascular structures. By evaluating anyparticular motion segment, thus better understanding the normal andabnormal movements at one level, one can better understood the spine asa whole, particularly when viewed as a series of adjacent motionsegments rather than merely a vertically stacked series of vertebrae.

It is felt that one problem in degenerative disease is that there isexcessive or abnormal movement between the vertebrae of one or morespinal motion segments. This is the basis for proposing surgical fusion,used for over 100 years now, which is a procedure in which the surgeoncreates a milieu which encourages the development of a bony bridgebetween the vertebrae of a target motion segment, thus uniting thesevertebrae into one large vertebra. Such a union would obliterate allmovement at the target motion segment. Ultimately, approximately 400,000 patients annually undergo surgical fusion of the spine in the UnitedStates alone, with more than a million performed globally. These numbershave been fairly stable over the past decade.

Unfortunately, between 15 and 30% of such surgeries do not result in anoutcome that the patient is satisfied with, and in fact a significantnumber of these patients report significant worsening of their symptoms.This syndrome, known as the so-called “failed back surgery syndrome,” or“post laminectomy syndrome,” is characterized by severe, chronicunrelenting pain which is poorly responsive to almost any intervention,as well as rather significant disability, and almost always associatedwith progressive severe depression and poor socialization. There aremany thousands of such patients currently here in America, and thispatient population creates an enormous drain on the health care deliverysystem. A system or device that would reduce this patient populationwould be of enormous value to the system.

Current technologies for establishing diagnoses all have shortcomings.Theoretically, the ideal patient who would optimally benefit fromsurgical fusion would be a patient who has a degenerative diseaseaffecting a particular spinal motion segment in which it can be clearlyshown that this spinal motion segment demonstrates an excessive Ipathologic amount of movement, and that this movement is the genesis ofthe patient's pain -the so -called “pain generator.”

Despite the superb imaging and diagnostic tools which are now availableto physicians and surgeons, demonstrating that this abnormal movement isunambiguously present, proving that this movement is responsible for atleast the majority of the patient's symptoms remains remarkablychallenging.

In addition to X-Rays and CAT scanning techniques, MRI scans have becomethe platinum standard for establishing diagnoses for the spine. But thishas also been shown to have its shortcomings, principally in the factthat MRI studies demonstrate at times significant degenerative changesin patients that are asymptomatic. Therefore, identifying such changesin a patient who is symptomatic does not absolutely establish a causalrelationship between the MRI findings and the patient's symptoms. Thiscan sometimes lead to conclusions by both patients and surgeons, andsometimes results in such patients undergoing fusion surgery which doesnot relieve the patient's symptoms, and sometimes results in worseningof these symptoms.

This is because in additional to mechanical causes or pain—mechanicalpain generators—there are other causes of back pain. It is well-knownthat there can be chemicals which are released locally which can lead toso-called “chemical pain generators. These may or may not be related toabnormal movements, so that stabilizing the spine with a fusion might,but is not guaranteed, to improve the pain.

Other issues that make back pain even more difficult to diagnose andtreat include the fact that in many technologically-advanced countries,in particular the United States, back pain is frequently associated withinjuries sustained in motor vehicle accidents, other injuries in whichthird parties are actionably responsible, or as the result of workrelated injuries. Such scenarios frequently result in litigation,resulting in the well-known phenomenon known as “secondary gain” causesof back pain. It is well documented that in many of these patients, onlythe favorable resolution of the associated litigation will result in afavorable resolution of the back pain.

A number of other pain generators have been identified or are alludedto, and added to that, it is well-known that back pain is a commoncomplaint in patients who suffer from a phenomenon known as somatizationdisorder. This is a clinical situation in which a patient experiencesand complains of back pain, and sincerely believes they are sufferingfrom back pain, but ultimately the pain is not found to be related toany identifiable pathoanatomic or pathophysiologic derangement. It isimportant to recognize that this disorder is different and distinct fromthe “secondary gain” phenomena discussed above, nor it is related tomalingering disorders or other issues in which the patient is cognizantthat he or she is amplifying the symptoms; in somatoform disorder, thepatient sincerely believes, in his or her soul, that he or she issuffering from some untreatable or rare disorder. Fusing such anindividual will, without exception, result in disaster.

Therefore, sorting these issues out and determining who would be bestserved by a surgical fusion is ultimately more challenging than it mayinitially appear. The concept of “functional” MRI studies, which woulddemonstrate whether pain signatures are present on thesespecially-programmed MRI studies, has been proposed for some time now,and may help resolve some of these issues. While this may havesignificant value in years ahead, it is likely that this technology willhave to undergo multiple scientific and legal challenges before it isfully accepted.

Another method which has been utilized, in one form or another, for manyyears in determining candidates for fusion surgery is discography. Firstintroduced in 1948, this technique involves passing a needle into atarget disc space and introducing X-Ray contrast into the disc space.The criteria by which the test is judged include the pressure requiredto inject the disc space, the radiologic appearance of the contrast asit flows into the disc space, and the symptoms reported by the patientat the time of the injection.

The value of discography has been a source of controversy for manyyears, and recently, has been under attack. Several studies haverecently shown that injection of “normal” disc space can accelerate discdegeneration, and in fact, it is thought that this technique mayprecipitate degeneration in discs which may not have otherwise developedpathology.

Several basic science studies have suggested that passing a needlethrough the annulus fibrosus (the cartilaginous ring surrounding theoutside of the disc) can—in and of itself—lead to disc degeneration;this is thought to be true even if nothing is actually injected into thedisc space. This may be related to a humoral response to the insertionof the needle, with this humoral response triggering the degenerativeprocess. If this can be shown to be unambiguously true, then thistechnique will likely be abandoned.

At one point, it was suggested that patients who might be candidates forfusion be placed in a back brace or possibly even a body cast todetermine their response to stabilization. There are several problemswith this approach. Firstly, there is good evidence that even a verysecure body cast allows a significant amount of subtle movement betweenvertebrae, and does nothing to prevent microinstability from occurring.Secondly, it can be argued that prolonged periods (weeks to months) in abrace, and especially in a body cast (which cannot be removed by thepatient) can have deleterious effects including a reduction of muscletone (which itself can lead to back pain) as well as skin irritationsuch as blistering and contact dermatitis, generalized deconditioning ofthe soft tissues of the spine, and other problems. This host of issuesoften occurs, and added to that is the fact that such a device may notanswer the critical questions: Is the patient's spine unstable? Is thisinstability the main cause of the patient's symptoms? And [ultimately]is fusion indicated?

Therefore, it remains necessary to develop a device and method whichwould allow a surgeon to transiently (over a period of a few weeks toseveral months) stabilize the spine in a manner that imitates theeffects of a fusion. Such a device would, of necessity, have to provideimmediate and secure stabilization

Such a device would stabilize a target motion segment in a fashion thatwould emulate a fusion, allowing the physicians attending to the patientto evaluate the patient's response to this type of stabilization over aperiod of time (weeks to months). In such a trial, if relief isreported, then the patient could be offered fusion. If the patientreported no improvement, or—of even greater importance—worsening of thesymptoms, then the device could be removed and the patient would beinformed that fusion should not be considered. Such a device would beunique, useful, novel and nonobvious.

BRIEF DESCRIPTION OF THE INVENTION

The invention relates to the general field of spinal surgery andspecifically to a device which is implanted onto a target motion segmentin such a way so as to stabilize said target motion segment withoutrequiring hardware, such as screws, to be implanted into the componentvertebrae.

This brief description of the invention is intended only to provide abrief overview of subject matter disclosed herein according to one ormore illustrative embodiments, and does not serve as a guide tointerpreting the claims or to define or limit the scope of theinvention, which is defined only by the appended claims. This briefdescription is provided to introduce an illustrative selection ofconcepts in a simplified form that are further described below in thedetailed description. This brief description is not intended to identifykey features or essential features of the claimed subject matter, nor isit intended to be used as an aid in determining the scope of the claimedsubject matter. The claimed subject matter is not limited toimplementations that solve any or all disadvantages noted in thebackground.

BRIEF DESCRIPTION OF THE DRAWINGS

So that the manner in which the features of the invention can beunderstood, a detailed description of the invention may be had byreference to certain embodiments, some of which are illustrated in theaccompanying drawings. It is to be noted, however, that the drawingsillustrate only certain embodiments of this invention and are thereforenot to be considered limiting of its scope, for the scope of theinvention encompasses other equally effective embodiments. The drawingsare not necessarily to scale, emphasis generally being placed uponillustrating the features of certain embodiments of the invention. Inthe drawings, like numerals are used to indicate like parts throughoutthe various views. Thus, for further understanding of the invention,reference can be made to the following detailed description, read inconnection with the drawings in which:

FIG. 1 is a frontal I transaxial view of the invention in place atL4-L5, with bilateral Facet Anchors in place on L5 and connected to asingle, central Spinous Anchor (at L4);

FIG. 2 is a right lateral view of the L4-L5 motion segment with theright side of the Spinofacet Stabilizer in position;

FIG. 3 is a posterior view of the L4-L5 motion segment after theapplication of the Spinofacet Stabilizer;

FIG. 4 is an elevational view of the Spinofacet Stabilizer from theright side;

FIG. 5 is a right lateral view of the Spinofacet Stabilizer with theFacet and Spinous Anchors isolated;

FIG. 6 is a posterior view of a disarticulated Spinous Anchor;

FIG. 7 is an elevational view of the Exploded Facet Anchor;

FIG. 8 is a lateral view of the cranial side of a Facet Base;

FIG. 9 is a transaxial view of the right L4-L5 facet joint with a FacetAnchor in Place;

FIG. 10 is a lateral view of the L4-5 motion segment during the firstphase of implantation;

FIG. 11 A and B are lateral views of implantation of the Facet Anchorand connecting rod;

FIG. 12 A and B are posterior views of implantation of the Facet Anchorand connecting rod;

FIG. 13 is a posterior view of multi-level iteration of the invention;

FIG. 14 is a posterior view of an alternative embodiment in which thespinous process is not used;

FIG. 15 is a posterior view of iteration stabilizing L5-S1;

FIG. 16 is a posterior view of variation of L5-S1 stabilization;

FIG. 17 shows an anterior view of an embodiment of the invention withtwo facet anchors 42, and 42 a; two extensions 43 and 43 a and twospinous anchor segments 44 and 44 b;

FIG. 18 shows the same embodiment as shown in FIG. 17, from the side;

FIG. 19 shows an embodiment of the facet anchor base using a clamp 51and a screw 52;

FIG. 20 illustrates another embodiment of the invention;

FIG. 21 illustrates the spinous anchor of the embodiment shown in FIG.17;

FIG. 22 is a posterior view of typical lumbar motion segment, in thiscase, L4-L5;

FIG. 23 is a lateral view of L4-L5 motion segment;

FIG. 24 is a transaxial view of L4-L5 motion segment;

FIG. 25 & FIG. 26 are lateral views demonstrating the reciprocalrelationship of the facet joints and disc during (A) Flexion (B)Extension.

SUMMARY OF THE INVENTION

This written description uses examples to disclose the invention,including the best mode, and also to enable any person skilled in theart to practice the invention, including making and using any devices orsystems and performing any incorporated methods. The patentable scope ofthe invention is defined by the claims, and may include other examplesthat occur to those skilled in the art. Such other examples are intendedto be within the scope of the claims if they have structural elementsthat do not differ from the literal language of the claims, or if theyinclude equivalent structural elements with insubstantial differencesfrom the literal language of the claims.

The principal object of the invention is to provide a unique, useful,novel and nonobvious device and method for use which is secured againstthe bony surfaces of a target motion segment of the spine, thusstabilizing said target motion segment. The invention achievesstabilization of a segment of the spine b without the use of pediclescrews, facet screws, spinous process plates or screws, staples, or anyform of hardware secured into any aspect of the target vertebraeresulting in violation of the cortical bone of the vertebrae comprisingthe target motion segment. It is yet a further object of the inventionis to disclose the design of the preferred and alternative embodimentsof such a device

In the preferred embodiment, the Spinofacet Stabilizer shall befabricated from surgical grade titanium. However, alternatively, thisStabilizer can be fabricated from surgical grade stainless steel, or ofalloys of any metal such as molybdenum, chromium, nickel, as well ascobalt, carbon fiber, polyester, ceramic, PEEK, organic materials suchas bone, or any other material currently known or proven to beacceptable to the art.

The invention will be best understood by providing the reader with atleast a rudimentary review of the pertinent anatomy. This can beappreciated by referring to FIGS. 21-26. These figures demonstrate atypical lumbar vertebral motion segment—in the example used it is theL4-L5 motion segment. The L4 and L5 vertebrae can be seen in variousprojections, along with the associated intervertebral disc. Nerves,muscles, tendons and ligaments are also components of the motionsegment, but are not illustrated for the purposes of simplicity. Thearticulation of any two vertebrae is accomplished anteriorly by theintervertebral disc (not well seen in the posterior view and best seenin Background FIG. 22) which is a specialized joint- defined by the factthat the disc serves as the junction between two bones (the vertebralbodies) and provides at least an element of movement between the twobones. Posteriorly, the articulation of the two vertebrae isaccomplished by the paired facet joints which are located bilaterally asseen in the posterior view in FIG. 22

As seen in FIG. 25, these joints are comprised of the lateral-mostaspects of the laminae of the superior vertebra of the motion segment,which forms a somewhat rounded almost hemispheric structure known as theinferior articular process; this, then, articulates with the cup-likesuperior articular process which is formed on the sides bilaterally bythe junction of the dorsalmost or most posterior aspect of the pedicleand the transverse process of the inferior vertebra of the motionsegment. One notes that the nomenclature may appear somewhat confusing.For example, although the “inferior articular process” is actually partof the superior vertebra, and is on the “superior” aspect of the facetjoint proper, this structure is nevertheless found at the inferioraspect of this vertebra, and because of this interpretation (naming thiscomponent in terms of its position on the vertebra rather than itscontribution to the facet joint itself) this component of the facetjoint is referred to as the “inferior articular process.”

In an analogous fashion, the contribution from the inferior vertebra ofthe motion segment is referred to as the “superior articular process,”despite the fact that it is actually somewhat more caudal in terms ofits relationship to the joint space proper. Again, this component isnamed in terms of its position on the vertebra.

These processes are also referred to as the inferior and superiorzygoapophyseal processes. For ease of interpretation, the term“articular processes” shall be utilized in this disclosure.

The broad dorsal aspect of the inferior articular process does notparticipate m the actual articulation. It is the lateralmost and ventralaspects of the lamina of the upper vertebra which actually interfacewith the superior articular process of the lower vertebra that createsthe joint space proper. As previously mentioned, the lateralmost andventral aspects of the inferior articular process create a hemisphericprofile as seen in the transaxial perspective. This then is accommodatedwithin the superior articular process, which is, in essence, a cup- likestructure, specifically designed to accommodate the inferior articular[cup-like] process. The lateral aspect of the superior articularprocess, then flows into the junction of the transverse process and thedorsal most aspect of the pedicle, creating the “FPT” complex. This isthe critical anatomic landmark for implantation of the Facet AnchoringElement. Extending medially from the medial aspect of this cup is a lipthat apposes the ventral aspect of the inferior articular process, thuspreventing this structure from becoming dislodged and shift anteriorlyinto the spinal canal. More dorsally, extending superiorly from thelateralmost aspect of this cup is another lip which prevents theinferior articular process from shifting laterally and dislocatinglaterally from the cup.

Although the facet joints participate in governing a range of differentmovements, their most important function is to limit extension of themotion segment. The joints also contribute to governing lateral rotationand lateral bending of the spine, and probably work in conjunction withthe disc joints in terms of the general governance of all the movementsof the spine.

The facet joints contribute to back pain directly because these jointsare richly innervated, and hence can be quite painful when injured.There is now considerable evidence that these joints can be relativelyeasily injured by hyperextension (particularly in the cervical spine),direct [blunt] trauma, and other mechanisms. In addition, these jointsare amongst the more common to be subjected to arthritic changes. Whensuch changes occur, the lips disclosed above can become hypertrophied,leading to enlargement of the joints with intrusion into the spinalcanal, resulting in consequent spinal stenosis. Such arthropathy is alsoattended by instability, and other issues.

This review isn't merely an academic exercise. Rather, this permits oneto recognize that the junction of the dorsalmost pedicle and the base ofthe transverse process with the lateral aspect of the superior articularprocess would be accessible to placement of one component of the devicebeing disclosed herein. Furthermore, this review allows one toappreciate the relationship of the transverse process to the joint, thusrendering this process a site for anchoring the device ventrally. Italso becomes apparent that the spinous process of the more superiorvertebra of the target motion segment is yet another excellent anchoringlocus, hence supporting the logic of the invention.

The invention disclosed shall be known hereinafter as the SpinofacetStabilizer, and in the preferred embodiment, shall be comprised of ananchoring element which is secured to the spinous process of one of thevertebrae comprising the target motion segment; it is anticipated thatin the preferred embodiment, this anchoring element will be securedagainst the spinous process of the superior or cranial vertebra of thetarget motion segment. This anchoring element is then coupled with atleast one anchoring element which is secured to the FPT complex on atleast one side of the second vertebra of the target motion segment;again, it is anticipate that in the preferred embodiment, this will bethe inferior vertebra of the target motion segment. Although it istheoretically possible to achieve stabilization by securing a singleanchoring element to the second [inferior or caudal] vertebra of thetarget motion segment, it is anticipated that in the preferredembodiment, and in the vast majority of clinical cases, two anchoringelements will be bilaterally secured to the inferior vertebra. Theseanchoring elements are coupled to each other by an elongated rod-likeconnecting feature, which may in fact, represent the connection ofelongated features which are provided to one or both of the anchoringelements, or may be a separate element.

In all preferred and alternative embodiments, that anchoring elementwhich is secured to the FPT complex shall be known henceforth as theFacet Anchoring Element, and is designed to be brought into locked,immovable apposition against the bony surface of the posterolateralaspect of the target vertebra; again it is anticipated that this willlikely be the lower I caudal vertebra of the target motion segment. Asingle Facet Anchor can be applied and may result in stabilization, butbiomechanical logic favors bilateral application. It is anticipated thatbilateral application creates the most secure grasp of the lowervertebra of the target motion segment.

The Facet Anchoring element is itself comprised of two constituentcomponents. The first of these components shall be known as the FacetBase, which is secured against the posterolateral aspect of the caudalvertebra of the target motion segment. Specifically, this component isapplied against the confluence of the lateral aspect of the superiorfacet process as this joins with the dorsalmost aspect of the pedicle,this confluence then joining with the posterior and medial aspect of thebase of the transverse process. For the purposes of this document, thistarget bony confluence shall be referred to as the FPT (facet I pedicleI transverse process) complex.

This Facet Base is provided with a leading end (which is brought intoapposition with the FPT complex) a body, and a trailing end (whichpasses over the posterior aspect of the facet joint proper). As viewedfrom the lateral perspective, there is a general rhomboid configurationwith a slant in the leading end as dictated by the anatomy of theconfluence of the transverse process with the posteriormost pedicle. Inthe preferred embodiment, the trailing end curves over the facet joint,and gives rise to the extension by which the Facet Anchor couples withthe Spinous Anchor. This extension shall be known hereinafter as thecoupling extension.

As viewed from the frontal (anatomically axial) perspective, in thepreferred embodiment, the body of the Facet Base is substantiallytriangular in configuration, with an expanded and somewhat curvilinearmedial aspect of the leading end, which is configured to achieve maximumapposition I interface with the target bony surfaces. It is alsoappreciated in this frontal I axial view that ideally, the leading endof the Facet Anchor is contoured to recapitulate the contour of thetarget bony anatomy, and in that way create the greatest interface withthe target bony surfaces.

The lateral aspect of the expanded leading end extends onto the proximalaspect of the transverse process. The lateral aspect of the body housesthe coupling mechanism of the Facet Base with the other component of theFacet Anchor, which is the Transverse Process Claw. A configuration inwhich the Transverse Process Claw is disposed from a more lateral aspecttowards the medial pedicle is the most biomechanically stable in termsachieving secure apposition of the Facet Anchoring Element.

When viewed from the anatomic posterior view, it is mostly the trailingend of the facet base which is seen; this appears to have a nearlytriangular configuration, with the lateral aspect of the base beingflattened, and the two sides approaching each other ultimately joiningwith the coupling extension. It is to be recalled that when viewing thepreferred embodiment of the invention from the anatomically posteriorperspective, Facet Anchoring elements would ideally be appliedbilaterally to the left and right FPT complexes.

As disclosed above, the second component of the Facet Anchoring elementis one or more Transverse Process Claws. In the preferred embodiment,this is a monolithic element which is provided with a leading end, ashaft, and a trailing end. The leading end is curvilinear in thepreferred embodiment, favorably designed to pass through soft tissuesduring its placement into its final desired position. Ultimately, it issecured against the surface of the junction of the anterior surface ofthe transverse process with the lateral aspect of the pedicle (referredto for the purposes of this document as the TPIP junction). In order toprovide a greater area of contact, the leading end has a broadened,slightly concave area which is configured to maximally appose the targetbony surface area. Maximal apposition may be further achieved byproviding the leading end of the Claw with a bias, to furtheraccommodate the slant of the bone as the pedicle conjoins with thetransverse process.

The shaft connects the leading end of the Claw to the trailing end; thetrailing end is coupled to the Facet Base in such a fashion that theTransverse Process Claw can be brought against the target bony surfaceswith maximum security. It is anticipated that this action will alsocompel the facet base to be brought securely against the FPT complex,the ultimate result causing the two constituent components of the FacetAnchoring Element to become securely locked against their target bonysurfaces thus locking the Facet Anchoring Element securely to theposterolateral aspect of the target vertebra in a unique, useful, noveland nonobvious fashion.

Multiple preferred and alternative embodiments of the components of theFacet Anchoring Element and the coupling of these components can beenvisioned. In fact, it can be recognized that the Facet Anchoringelement has the potential for the greatest number of variations of anyof the elements which comprise the Spinofacet Stabilizer. This isbecause of the potential variations in the Transverse Process Claw,implantation thereof, as well as the manner in which this Claw iscoupled with the Facet Base. However, it is understood that those wellversed and skilled in the art may envision and conceive of yet otherconfigurations which would achieve such an endpoint. All suchembodiments are contained within the spirit and scope of thisapplication for this invention.

In the preferred embodiment of the Facet Anchoring Element, the FacetBase would be substantially configured as described above. A singleTransverse Process Claw is irreversibly coupled to the superior Icranial aspect of the Facet Base. An advantage to utilizing a singlecranial Transverse Process Claw which is implanted from a superior orcranial approach is that this would virtually eliminate the possibilityof injuring the nerve root, which classically escapes from the spinalcanal along the caudal aspect of the associated pedicle.

The Transverse Process Claw is coupled to the Facet Base by providing anaperture to the cranial side of the body of the Facet Base, saidaperture then being continuous with a chamber within the body. In acorresponding fashion, the trailing end of the Claw is provided with acoupling peg which arises in an orthogonal fashion to the long axis ofthe trailing end of the shaft of the Claw. The outer diameter of thecoupling peg is slightly larger than the inner diameter of the aperture,creating a snug, “pressure-fit” when the peg is inserted through saidaperture and into the chamber. This arrangement will establish thecoupling peg as the axis of rotation around which the Transverse ProcessClaw can rotate into the desired position. Moreover, this junctionbecomes a fulcrum with the two elements of the Facet Anchor acting aslever arms as they are brought against the target bony surfaces. Hence,the coupling of the transverse process claw with the facet base servesas an actuator which, in effect, clamps the Facet Anchoring Elementagainst the posterolateral aspect of the target vertebra. This is morebiomechanically stable arrangement in a dynamic biomechanical site suchas the spine.

In the preferred embodiment, the leading end of this coupling peg isprovided with a series of regularly-spaced corrugations. Thesecorrugations arise generally orthogonal to the long axis of the couplingpeg, and are designed to interface with a complimentary series ofcorrugations which have been provided to the surface of the chamber,which creates a ratcheting mechanism between the peg and the chamber. Inthe process of implanting the Facet Anchor, the Transverse Process Clawis rotated towards the target bony surface, and said ratchetingmechanism will compel the Transverse Process Claw, and in turn cause theFacet base to be drawn anteriorly and cinched against the FPT complex.Again, this rotation will, in the most ideal of circumstances, alsoprovide secure fixation of the Facet Anchoring element to theposterolateral aspect of the target vertebra.

Of course, the types of the adjustable coupling of the Facet Base withthe shaft of the transverse process may include a ratcheting mechanism,a “cold weld” process, or any other process which would result in anadjustable coupling between two components. All such mechanisms would beincluded within the spirit and scope of the invention.

The second element of the Spinofacet Stabilizer shall be known as theSpinous Anchor, which is a modular element and shall be comprised of atleast two or more components which, when adjustably coupled together,create a substantially oval ring which is secured around the base of thespinous process of a target vertebra. In an embodiment utilizing twocomponents, each of these components consists of a hemi-ellipse whichare configured such that when coupled together they form an ellipsewhich can be secured to the base of the target spinous process. In thepreferred embodiment, the hemi-ellipses are adjustably coupled, with aratcheting mechanism or some other adjustable coupling mechanismprovided to the hemi- ellipses. It is considered rather important thatthe components of the Spinous Anchor are adjustably coupled together sothat the Anchor can be securely fitted around the spinous process.Therefore, in the preferred embodiment, each of the hemi-ellipses are inturn comprised of two elements which are adjustably coupled together,generally along the craniocaudal axis, further ensuring that a securefit around the spinous process is achieved.

The third feature of the Spinofacet stabilizer is an elongated rod-likeconnecting element. This feature may represent a separate element whichis adjustably coupled to the Spinous Anchor as well as the as the FacetAnchoring Element, said coupling causing the Spinofacet stabilizer toprovide fixation to the target motion segment in a unique, useful, noveland non-obvious fashion. However, in the preferred embodiment, thiselement actually represents the coupling of elongated extensions of theFacet Anchoring Element and the Spinous Anchoring Element. It must, ofcourse, be recalled that any other embodiments which can be envisionedby those skilled in the art are all included within the spirit and scopeof the invention.

In the preferred embodiment, the leading end of the Facet CouplingExtension arises from and is ideally monolithic with the trailing end ofthe Facet Base. This Extension is also provided with a shaft and atrailing end, the shaft of which is directed medially and slightlysuperiorly.

The trailing end shall couple with the leading end of asimilarly-configured extension arising from the Spinous Anchor. Theconfiguration of this coupling is unique, useful, novel and nonobvious.

The trailing end of the extension arises from and is ideally monolithicwith the one of the hemi-elliptical elements of the Spinous Anchor. Thisis then continuous with a shaft which terminates in the leading end ofthe Spinous Anchor Coupling Extension. The leading end then couples withthe Facet Coupling Extension. When this is accomplished [presumably]bilaterally, the Spinofacet Stabilizer confers stability to the targetmotion segment.

The unique, useful, novel and nonobvious coupling of the trailing end ofthe Facet Anchor Extension with the leading end of the Spinous AnchorExtension is accomplished by providing the ends of said Extensions witha unique configuration in which these ends, as seen in a transverseperspective, are slightly oblate rather than perfectly round, andtherefore longest in one diameter (be it vertically or horizontally) andshortest in the orthogonal axis. Furthermore, the outer surfaces ofsides of the longest diameter are substantially roughened so as topromote a “cold weld,” when interfacing with another roughened surface.The exterior surfaces of the sides corresponding to the shortestdiameter are smooth. It must be noted that in the preferred embodiment,the diameters of the Extensions as well as the textures of their outersurfaces should be parallel, although other configurations can beenvisioned, which are of course within the spirit and scope of theinvention.

Furthermore, this coupling is accomplished by another independentelement known as the Coupling Modulator. This element is irreversiblycoupled to one of the free ends of the Extensions. This is substantiallycylindrical in configuration, the external surface of which is providedwith a mechanism, be it ridges, a thumbscrew, or any acceptablemechanism for rotating the Modulator; thus, it allows the operator torotate the Modulator around the long axis two Extensions, which can beseen entering the [open] sides of the cylindrical-shaped Modulator. Itcan be seen that ultimately, the coupling of the two Extensions is, infact, actually the result of the coupling of each of the free ends tothe Modulator.

In the example set forth here, the Modulator is coupled with the FacetCoupling Extension; it is borne in mind that an embodiment in which theModulator is coupled to the Spinous Anchor Extension, as well asembodiments in which the Modulator is a completely independent elementwhich is placed at the time of assembly are all incorporated into theSpirit and Scope of this disclosure.

The Modulator is a cylinder with a central channel passing therethrough,and apertures at each end which are continuous with said channel. TheModulator is irreversibly coupled to an extension by providing a slightenlargement of the circumference of the trailing end of the Extension ata point just beyond the aperture of the Modulator through which theshaft and trailing end of the extension are disposed. The geometry ofthis configuration is such that it permits free rotation of theModulator but does not permit dislodgement thereof.

It can be understood that while the Modulator is irreversibly secured toone Extension, the other Extension can be disposed through thecorresponding aperture such that the free ends of both Extensions arethen housed within the channel of the Modulator. Again, in the exampleset forth, the leading end of the Spinous Anchor Extension would be freeto be disposed into the channel of the Modulator.

As a practical matter, upon passing the free end of the Spinous Anchorinto the Modulator, the surgeon or operator can then either distract orcompress the target motion segment. This is a unique aspect of theinvention when compared to any facet fixation systems which arecurrently on the market or in development.+

Once the motion segment has been adjusted to the desired craniocaudaldimension, the Spinofacet Stabilizer is locked in place. This is resultsfrom the coupling of the two Extensions to the Modulator. As has beendisclosed the free ends of the Extensions are provided with a uniquegeometry, as well as opposite sides in which the exteriors canparticipate in a cold weld. These features are critical to the desiredcoupling.

The interior surface of the central channel is also uniquely modified toparticipate in this coupling. This channel is also slightly oblaterather than perfectly circular. In the non-deployed position, thegreatest diameter of the channel is parallel to the greatest diameter ofthe Extensions. Furthermore, the sides of the smallest diameter of thechannel are roughened to engage in a cold weld, while the sidescorresponding to the longest diameter are smooth. This is opposite ofthe arrangement seen in the Extensions, wherein the sides of the greaterdiameter are roughened. It is again emphasized that the choice of whichdiameter is longest in the Extensions as well as the channel is somewhatarbitrary, and any such combination of diameters of the Extensions andChannel are within the spirit and scope of the invention.

It can now be seen that in the non-deployed position, the longestdiameters of the two Extensions as well as the longest diameter of thechannel of the Modulator are aligned, and that the smooth surfaces ofthe channel are aligned with the roughened surfaces of the Extensionswhile the roughened surfaces of the Extensions are aligned with thesmooth surfaces of the channel.

Moreover, it is noted that rotating the Modulator approximately 90° willresult in a re-alignment of these surfaces and diameters, such that withsuch a rotation, the roughened surfaces of the Extensions as well as thechannel are now enmeshed creating a cold weld. Furthermore, aligning theshortest diameter of the channel with the longest diameter of theExtensions will create a mechanical “pressure-fit” lock, providingadditional security to this important coupling.

Implantation of the Invention

In the preferred embodiment, the Spinofacet Stabilizer is implantedthrough a single limited midline incision. This is created from thelower half of the more cranial target spinous process to the uppermostportion of spinous process of the inferior vertebra. Such an incisionwould expose enough bony landmarks to allow the surgeon to complete theprocedure in an efficient manner, while limiting the amount of tissuetrauma and injury. An additional advantage for patient, surgeon andstaff is that such an approach would limit the amount of radiation thatwould necessarily be utilized during the procedure.

The fascial attachments to the spinous process are then taken down, andthe fascia in the midline is opened between the two spinous processes. Amonolithic, purpose-specific blunt probing instrument, known as theSub-fascial Dissector, is then introduced, which is provided with aleading end, a shaft and a trailing end. The purpose of the sub-fascialdissector is to create a tract from the spinous process to the FPTcomplex which will accommodate and seat the Facet Anchor and CouplingExtension, which is the initial step in implantation.

The leading end of the Sub-fascial Dissector is conical inconfiguration, with a blunted leading most end. It is further providedwith a small extension, the FPT finder, which arises from the bottom ofthe leading end and is oriented and directed orthogonal from the longaxis of the leading end. This FPT finder would, in reality, be directedanteriorly when the instrument is being utilized.

The junction of the leading end with the shaft is curvilinear such thatthe leading end is directed 60-90° from the long axis of the shaft. Theshaft is then continuous with the trailing end, which is provided withhandgrips for use by the surgeon. The instrument may be fabricated fromany material known or acceptable to the art.

The surgeon introduces the FPT finder to create a sub-fascial tractthrough the muscles attached to the lamina and the facet joint, as wellas the posterior surface of the transverse process. It is anticipatedthat in the preferred embodiment the Spinofacet Stabilizer is attachedand rests entirely outside of the periosteum, with minimal disturbanceof the periosteum. This is to reduce any inflammatory response whichmight be precipitated by significant disruption of the periosteum.

Introducing the Sub-fascial Dissector initially with its leading enddirected anteriorly, the curvilinear configuration allows the surgeonrotate the dissector such that once the leadingmost end approaches themedialmost aspect of the lamina of the more cranial vertebra, and inthis way advance the leading end towards the FPT complex. Once rotated,as the Dissector is advanced laterally, the FPT finder will detect thepresence of the bony lamina as well as the step-off created lateral tothe facet joint. Once this has been dissected cleanly and a tractcreated, the Dissector is removed.

Examination of the preferred embodiment of the Facet Anchor reveals thatthe geometry created by the relationship of the Transverse Process Clawto the Facet Base dictates that implantation of the Facet Anchor can beaccomplished by one of three methods: 1) The Anchor is introducedthrough an incision directly posterior to the FPT complex, andspecifically the Anchor is introduced with the leading end of theTransverse Process Claw and the long axis of the Facet Base parallel tothe cranial aspect of the transverse process and rotated into thedesired position; 2) The Anchor is introduced from a direct posteriorincision such that the Facet Base is brought against the FPT complex andinto its desired position, with the Transverse Claw initially in anon-deployed position parallel to the cranial edge of the transverseprocess, and then the Claw is rotated into the final desired position,or 3) The Anchor is introduced at a bias to its final desired position,and then the Anchor is rotated into the final desired position. Thislast approach could be undertaken from either a direct posteriorincision, or using a single midline incision as being described herein.However, those familiar with the art may envision other strategies whichcan be used to introduce the Facet Anchor; all such embodiments areincluded within the spirit and scope of this application.

At this point, a unique, useful, novel and nonobvious instrumenthereinafter referred to as the Facet Anchor Securing instrument isintroduced. This instrument is provided with a leading end, a shaft anda trailing end. The instrument is to be fabricated from titanium,stainless steel, plastic, or any other substance known or acceptable tothe art. The trailing end is a straight component which is a handle usedby the surgeon to manipulate the instrument and thereby position theFacet Anchor in place; the trailing end of the instrument is also usedto actuate the Securing Instrument at the time of implantation of theFacet Anchor. There is a curvilinear junctional area connecting thehandle of the trailing end with the shaft. It is this curvature thatallows the surgeon to direct, through a midline incision, the uniqueleading edge to implant the Facet Anchor into a more lateral position.This leading end has a somewhat blunted, cone-shaped leading most endwhich further dissects the soft tissues (muscle, tendons, ligaments,etc.) in preparation for the placement of the Facet Anchor.

The leading end is provided with a cradle which is configured toreversibly couple with the Facet Anchor and house it while the SecuringInstrument is disposed through the soft tissues posterior to thevertebral column. This cradle maintains the Facet Anchor oriented toachieve its final desired position.

Several methods for actuating this instrument can be envisioned.Additional methods which may be anticipated by those familiar with theart would, of course, be included in the spirit and scope of thisapplication. One such preferred method is achieved by providing theleading end of the instrument with a series of inflatable bladders whichare pneumatically or hydraulically driven. The desired medium istransferred to the bladders via a series of tubes I channels whichextend throughout the length of the Securing Instrument. At the trailingend, access portals to these tubes I channels provide the surgeoncontrol over these bladders.

With inflation of the actuating bladders, the Anchor is held in aposition biased to the final desired position, with the leading end ofthe Transverse Process Claw being held somewhat cranially andposteriorly to its final desired position. Upon positioning the Anchorwithin the leading end of the Securing Instrument, the surgeon thendisposes the instrument through the tract which was created by theSubfascial Dissector. The leading end and shaft of the SecuringInstrument are narrowed in comparison to the expanded leading end inwhich the Anchor is secured. With this configuration, the surgeon cantactilely identify the facet joint and the depression containing the FPTcomplex lateral to the facet joint. In an alternative embodiment, theSecuring Instrument is positioned initially without the Facet Anchorsecured into the leading end of the Instrument. In this embodiment, thetrailing end and shaft have a central channel through which the FacetAnchor can be disposed, and then brought into final position byactuation of the leading end.

Upon identifying FPT complex, the instrument is further actuated bydeploying and filling actuating bladders that are strategicallypositioned within the leading end of the Securing Instrument. Withinflation of these bladders, the Facet Anchor is rotated around the baseof the transverse process, and into position for final deployment. Thisrotation compels the Transverse Process Claw to now be anterior to theanterior surface of the transverse process, and in position to bebrought against the TP/P surface; the Facet Base has now been broughtagainst the FPT. The final set of bladders is now deployed, resulting inrotation of the Transverse Process Claw against the TP/P surface, andcompressing the Facet Base firmly against the FPT complex. This locksthe Facet Anchor into final position; the combination of these twoactions results in the Facet Anchor becoming “cinched” against theposterolateral aspect of the target vertebra. It is to be recalled thatbarring special circumstances determined by the surgeon, this wouldroutinely be performed bilaterally. At that point, the SecuringInstrument can be removed.

It is critical that the trailing end of the Facet Anchor, which is inreality the trailing end of the Coupling Extension, remain easilyidentified rather than becoming completely covered over with softtissues, resulting in difficulty in finding when the time comes forcoupling with the Spinous Anchor. Therefore, an instrument known as theSpinofacet Locking Instrument is provided. This instrument is alsoprovided with a leading end, a central portion, and a trailing end, andserves two functions: it makes the trailing end of the Facet Extensioneasily presentable for coupling with the leading end of the Extensionarising from the Spinous Anchor; additionally, the Locking Instrumentreversibly couples with the Coupling Modulator and allows the surgeon tolock the coupling of the two extensions.

The leading end of the Locking Instrument is provided with aconfiguration which will interface with the exterior surface of theCoupling Modulator, such that it can be left in the “non-deployed,”setting while the Spinous Anchor is being implanted. In this way, it iseasily identified when coupling the extensions is desired. Once thesurgeon is satisfied with the position of the Spinofacet Stabilizer aswell as the degree of distraction I compression of the vertebrae, thesurgeon actuates the Locking Instrument which in turn rotates theCoupling Modulator which locks the two Coupling Extensions in place

The central portion of the Locking Instrument is, in the preferredembodiment, provided with an approximately 90° curvature. This wouldallow the leading end of the instrument to be placed on the CouplingModulator at the moment of the removal of the Facet Anchor SecuringInstrument so that the trailing end of the Facet Extension does notbecome obscured by soft tissues; furthermore, the trailing end of theLocking Instrument could be laid against the skin, thus being kept outof the way until it is time to secure the Coupling Modulator. Thetrailing end provides the surgeon with a handle for placing and removingthe instrument.

The next step in the insertion is to again utilize a blunt dissectorwhich is purpose specific and known as the Spinous Process Dissector.This instrument is provided with a trailing end from which the devicecan be actuated. A central portion of the instrument then connects thetrailing end with the leading end, which is provided with dualprong-like extensions which are used to create tracts through the softtissues which will then accept the hemi-ovular shaped components of theSpinous Anchor.

The two halves of the Spinous Anchor are then inserted with theassistance of another unique, purpose-specific instrument, the SpinousAnchor Inserter. This instrument is provided with two separate leadingends which, in the preferred embodiment, are reversibly coupled to acentral portion. The central portion is provided with two extensionswhich couple with the leading ends and which, in turn, are monolithicwith a trailing end. The central portion of each extension isirreversibly coupled to its fellow by a pivot bolt which creates ascissoring configuration which is actuated by deploying the trailingend; this configuration is essential to the implantation of the SpinousAnchor.

The leading end of each half is further provided with a cradle by whichit can reversibly couple with one of the hemi-ovular elements of theSpinous Anchor. The cradles are provided with a release mechanism suchthat once the Spinous Anchor is implanted, the cradles will be releasedfrom the hemi-ovular elements. Additionally, another unique feature ofthe Inserter is a pivotable joint at the junction of the leading endwith the central shaft. This creates a situation which is ergonomicallyfavorable insofar that the components of the Spinous Anchor can bedisposed through the skin incision with their long axis orthogonal tothe skin, and then this pivotable mechanism is deployed, rotating thecomponents 90° so they can then be fitted into the proper positionagainst the spinous process.

The central portion connects the leading ends to the trailing ends, andprovides the important pivoting mechanism needed for the function of theinstrument. The trailing mechanism is provided with handles by which theinstrument can be deployed.

Deployment of this instrument involves mounting the two halves of theSpinous Anchor on to the two, separate leading ends of the Inserter. Theimportance that the leading ends of the Inserter are separate elementsarises from the fact that each half of the Spinous Anchor includes aCoupling Extension; these extensions be initially coupled (but notlocked in final position) with the Coupling Extensions of the FacetAnchor. This is most easily accomplished, from a mechanical perspective,prior to uniting the halves of the Spinous Anchor. Therefore, each halfof the Spinous Anchor is coupled with a leading end of the inserter,disposed through the minimal incision and the two Coupling extensionsare coupled within the Coupling Modulators. At this point, the CouplingModulator remains in the non-deployed position.

Once the two Coupling Extensions of the Spinous Anchors are ideally inapposition with the trailing end of the Facet Anchors, the CouplingExtensions are coupled by deployment of the modulator. At that point,the independent leading ends of the Spinous Anchor Inserters are coupledwith the central portion.

Upon this action, the two halves of the Spinous Anchor are nowpositioned in close apposition with each other. Deployment of thetrailing end of the Spinous Anchor inserter results. The exactconfiguration of the leading ends places and maintains the two halves ofthe Spinous Anchor astride the spinous process, in the positionnecessary for the two halves to couple and form the Spinous Anchor. Thisis accomplished by a configuration in which the junctions of the leadingends and central portions of the Inserter are provided with anapproximately 90° angle. This allows the Inserter to negotiate thecomponents of the Spinous Process Anchor into position through a minimalincision.

In the preferred embodiment, the junctions of the central portions withthe trailing ends are also monolithic, and again provided with anapproximately 90° angulation. This is to provide the surgeon with anoptimal ergonomic advantage during implantation. With thisconfiguration, deploying the scissoring action of the Inserter allowsthe two halves to be brought together. Furthermore, the scissoringaction of the Inserter allows the two halves of the Spinous Anchor to becompressed towards each other, thus actuating the ratcheting mechanismsof the components of the Spinous Anchor, ultimately resulting in asecure fit around the base of the spinous process. Such a fit isnecessary in order to achieve the desired stability of the SpinofacetStabilizer, and to create the unique, useful, novel and nonobviousspinal stabilization method herein disclosed.

Additionally, in the preferred embodiment, each half of the SpinousAnchor are, m turn, composed of two elements which are ratchetablycoupled with each other such that they can be compressed along thecraniocaudal axis, thus further compressing the Spinous Anchor againstthe spinous process. This increased fit is advantageous inasmuch thatthis further contributes to the stability of the construct. In such anembodiment, the Spinous Anchor Inserter is provided with a configurationwhich will allow actuation I deployment of the Inserter leading tocompression of the halves of the Spinous Anchor in a craniocaudaldirection.

As a final step in the implantation process, distraction or compressionof the target motion segment must be established. This is done prior todeploying the Coupling Modulator, which would securely lock the CouplingExtensions, conferring the desired stability to the entire construct.Distraction or compression is established by yet another purpose -specific instrument, which is configured to interface with the SpinousAnchor as well as the Coupling Modulator.

In this embodiment, the bilateral Coupling Modulators will reversiblycouple with the bilateral leading ends of the Vertical Adjuster, whichis substantially “V” shaped, with the apex of the V reversibly couplingwith the spinous process and I or the Spinous Anchor. Arising from thiscentral element are the aforementioned adjustable arms. Once coupledwith the Coupling Modulators, the arms can be further extended, leadingto distraction of the motion segment. Alternatively, these arms can beretracted, thus leading to compression of the segment. This maneuvercompletes implantation of the invention.

It should be noted that in situations where extensive distraction orcompression is desired, it may be necessary to provide trailing ends ofthe Facet Anchors, and possibly the trailing end of the Spinous Anchors,with a swiveling mechanism to allow for the change in the orientation ofthe connecting elements bilaterally precipitated by change inorientation of the Anchor elements with respect to each other after asignificant distraction or compression. Such a mechanism can beenvisioned as swiveling on a peg or similar structure connected to thecentral portion of the Facet Base. Clearly, it would also be necessaryto be able to reversibly lock such a swiveling mechanism once thedesired position is achieved.

Alternate Embodiments

One can envision multiple alternative embodiments of the invention; themost obvious of these are disclosed herein. It is to be recalled thatthose skilled in and familiar with the art may envision and offer otherembodiments; such embodiments are also, be reference, included withinthe spirit and scope of the invention.

The first alternative embodiment disclosed herein addresses the issue ofapplication of a Spinofacet Stabilizer to the L5-S1 segment. A moment'sreflection will reveal that as there is no transverse process associatedwith the first Sacral segment, a significant alteration of the FacetAnchor will be necessary in order to utilize the device at this [mostcaudal] motion segment.

The inventor anticipates an embodiment in which a semicircular Ihemi-ovoidal base can be brought against the cranial edge of the alarwings of the sacrum. It is expected that this base can be pressurefitted against the sacrum; an adjustable mechanism can be incorporatedinto the base for an even more secure fit against the sacrum. This baseis then connected through an adjustable rod (as disclosed below) to theSpinous Anchor which would be secured to the L5 spinous process. Thisembodiment would likely be most useful in cases where distraction of themotion segment is desired.

In another embodiment of applying the invention to the L5-S1 motionsegment, a curved bracket is passed along the caudal border of thesuperior facet process of S1. At that point, the two anchoring elementsare distracted slightly. This distraction will then fixate the curvedbracket against the S1 superior facet process.

Another alternative embodiment is disclosed for use at multiple levels.Obviously, one could merely apply individual Spinofacet Stabilizers tothe target levels, achieving the desired result.

A Spinofacet Stabilizer can be specifically designed for application tomultiple levels. In this embodiment, the multiple Spinous Anchors areconnected by a bridging element.

Another aspect of this invention which can be achieved by multiplealternative embodiments is the coupling of the Transverse Claw to theFacet Base. In the preferred embodiment it can be recalled that the ClawI Base complex is initially implanted with the Claw oriented parallel tothe long axis of the transverse process, and then the complex is rotatedso that the Claw is then anterior to the process. At that point the Clawis rotated into final position against the lateral aspect of thepedicle.

The Numerous alternatives which can be anticipated can be generally bedifferentiated according to the method by which the Claw is broughtagainst its target bony area, as well as the coupling of the Claw to theFacet Base.

Finally, the method of implanting the Facet anchors can vary. Ingeneral, this could be anticipated to include the preferred methoddisclosed above, utilizing a single midline incision in concert with aninsertion instrument which passes the Facet Anchor into its initialposition and then actuates the final positioning of the anchor element,including the positioning of the Transverse Claw.

Alternatively, the Spinofacet Stabilizer could be implanted through aminimal midline incision, as well as two small incisions centered overthe facet complexes bilaterally. In this implantation approach, it isanticipated that initially, after accomplishing the aforementionedincisions, implantation cannulae would be bilaterally disposed throughthe lateral skin incisions and brought against the target bony area ofthe FPT complex. Then, the Facet Anchors would be disposed through thecannulae; it is anticipated that with this approach, it would betechnically easier to manipulate the Facet Anchor, and a variety ofapproaches could be utilized in order to lock the Transverse Clawagainst the target bony area.

For instance, in one embodiment, the Claw is attached to the Facet Basein such a way that upon initial implantation, the long axis of the Clawis parallel to the long axis of the transverse process. Once the FacetBase has been brought securely against the FPT complex, the Claw isfirst rotated (approximately 90°) so that its long axis is (in its finalposition) orthogonal to the long axis of the transverse process, withthe Claw anterior to the transverse process at its junction with thelateral aspect of the pedicle. At the point, the Claw is slidablyrepositioned along an anterior-posterior axis (In the transaxial viewthis would appear to be “up” and “down”) such that the Claw can besecurely brought against the target bony areas.

In yet another embodiment of the Facet Anchor, the Facet Base and theshaft of the Transverse Claw are coupled at the lateralmost aspect ofthe anchor. The long axis of the Claw is, in this embodiment, parallelto the long [craniocaudal] aspect of the Facet base, such that the Clawdoes not require rotation into position. The Facet Anchor is implantedby approaching the FPT complex from superior to the cranial aspect ofthe transverse process, and positioned with the Facet Base against theFPT complex and the Claw anterior to the transverse process. At thatpoint, using the coupling of its two components as a fulcrum, the FacetBase and the Transverse Claw are compressed towards each other toprovide a secure fit against the target bony areas.

In yet another embodiment, the Transverse Claw is semi-circular inconfiguration, and is contained within the body of the Facet Base in itsnon-deployed position. Implantation then proceeds initially withplacement of the Facet Base against the target bony areas; once inposition, the Transverse Claw is deployed by being rotated out of thebody of the Facet Base and around the cranial edge of the transverseprocess, to be brought against the target bony area.

DETAILED DESCRIPTION OF THE DRAWINGS

Background views have been provided to identify and define anatomicstructures as well as the anatomic relationships, which are critical inunderstanding the function of the invention as it is applied to thespine. In both the Background Figures and the Figures demonstrating theinvention, the exemplary motion segment demonstrated is the L4-L5 level;however, it is understood that with minor anatomic variations, theexample set forth herein could be applied to any motion segment fromT2-T3 to L4-L5. L5-S1, of course, has a unique anatomic arrangement, andis discussed and demonstrated in “Alternative Embodiments.”

In FIG. 22, a posterior view of a typical L4-L5 motion segment has itsnatural anatomy demonstrated. The intervertebral disc 100 is not wellseen in this posterior view as it is interpositioned between the upperL4 vertebral body 101 and the lower L5 vertebral body 102, both of whichare also better appreciated in other views. The prominent midlinestructures are the spinous processes of L4 103 and L5 104, the tips ofwhich are projected out towards the reader. The bases of these processes(105, 106) are better seen in the lateral view (Supplemental FIG. 2).Bilaterally projecting from the sides of the L4 vertebra is the lefttransverse processes 107 and the right transverse process 108.Similarly, at L5, the left and right transverse processes 109, 110 canbe seen. This view best demonstrates the broad, flat laminae of bothvertebrae, referring to L4 left-sided lamina 111 and right sided lamina112, as well as L5 left and right, 113, 114; these plate-like structuresform the “roof” or posterior aspect of the spinal canal, an effect whichis best appreciated in the transaxial view I Supplemental image 3. Alsoseen in FIG. 1 is the posterior presentation of the zygoapophysealjoints, more commonly referred to as the facet joints 115 and116—structures which are central to this disclosure. These joints arecomposed of the left and right inferior articular processes 117, 118,which are contributed by the upper or more cranial vertebra, and theleft and right superior articular processes, which are contributed bythe lower or more caudal vertebra. Pursuant to that arrangement, one cansee the left 115 and right 116 L4-L5 facet joints, which are composed ofthe left 117 and right 118 L4 inferior articular processes, as well asthe left 119 and right 120 L5 superior articular processes. Theunarticulated L4 superior articular processes 125, 126 can be seen atthe top of the motion segment, as can the unarticulated L5 inferiorarticular processes 127, 128. Importantly, it can be seen that thejunctions of the Transverse Process with the Superior Articular Processpresents a critical surface; this is the posteriormost portion of thepedicle (Best seen in the lateral perspective, Supplemental Image 2) andthis area represents the FPT complex on the left 129 and right 130[stippled areas], which are the sites against which the Facet Anchorswill be brought.

In FIG. 23, a lateral perspective of the right side of the L4-L5 motionsegment, composed of the intervertebral disc 100, and several structureswhich could not be fully appreciated in the posterior view are nowreadily apparent. Most prominent of these is the large, anteriorlylocated Vertebral Bodies of L4 101 and L5 102. The right L4 Pedicle 122and L5 Pedicle 124 are seen connecting the anterior Vertebral Bodies 101and 102 to the posterior elements (the left sided L4 and L5 pedicles121, 123 and the left neuroforamen 131 are not seen in this view). Theopening between the right pedicles 122, 124 is the right L4-5neuroforamen 132, from which the L4 nerve root (not demonstrated herein)would exit from the spinal canal. The right L4 Transverse Process (TP)108 and L5 TP 110 can be seen projected The lateral aspects of the rightL4-L5 facet joint 116, specifically the lateral aspect of the right L4inferior facet process 122 as well as the right L5 superior articularprocess 124. The right-sided L4 and L5 laminae 112, 114 can be seenextending from the L4-5 facet complex 116 to join the base 105 of the L4spinous process 103 and the base 106 of the L5 spinous process 104.Again, the unarticulated right sided superior articular process of L4126 as well as the unarticulated inferior articular process of L5 128are seen at the lateral extremes of the image. The stippled area is seenas the L5 FPT complex 130, where the facet anchor would be secured in aconstruct restraining this motion segment.

In FIG. 24, a transaxial view, as seen from the cranial or superiorperspective, at the level of the L4-5 disc space is seen. It is to berecognized that given this perspective, the subject's “left-sided”structures are portrayed on the viewer's right, and conversely, thesubjet's “right-sided” structures are portrayed on the viewer's left.This is the best view to understand how the laminae (in this case theleft and right L4 laminae 111, 112) form the “roof,” of the spinalcanal. Surgeons often use the parlance “Unroofing the canal,” whenremoving part or all of the lamina (i.e. “laminectomy,”) to treatpathologies such as disc herniation and spinal stenosis, which affectintracanalicular structures such as the spinal cord, the cauda equina,and the nerve roots as the enter the neuroforaminal canals. In this casethe left 131 and right 132 L4-5 neuroforaminal canals can be seen,although nerve roots are not demonstrated herein. The large rounded Iovoid intervertebral disc 100 is seen anteriorly, with the left 123 andright 124 L5 pedicles extending posteriorly, dividing into the left 119and right 120 L5 superior facet processes and the left L5 109 and right110 transverse processes. The pedicles can also be understood asconnecting the vertebral body of L5 102 to the facet joints 115, 116,the laminae 113, 114 and the spinous process 104 (not well seen) of L5;collectively, this group of structures are referred to by functionalanatomists as the “Posterior ring.” The junction of the posterior aspectof the pedicles 123, 124, the transverse processes 109, 110 and thesuperior facet processes 123 and 124 together form the “FPT” complexes129, 130 [stippled], which is the target for placement of the FacetAnchors. Also seen in this view is a transverse perspective of the L4-5facet joints 116, 117, composed of the L4 inferior articular processes118, 119 articulating with the L5 superior facet processes 120 and 121.The left 118 and right 119 L4 inferior articular processes are seenflowing into and continuous with the left 112 and right 113 L4 laminae,which then meet in the midline and form the base 105 of the L4 spinousprocess 103.

In FIG. 25: This transaxial view of the L4-5 facet joint as arepresentative joint recapitulates and further refines the anatomy ofthe facet joint illustrated in FIG. 23. In this image, the view isdemonstrated from a cranial perspective, as this would offer a moredetailed view of the anatomy which is anticipated to be the approach inimplanting the Spinofacet Stabilizer. In this view, the lateralmost partof the left L4 lamina 112 is seen terminating in the left L4 inferiorarticular process 118. The terminal portion of the left L5 pedicle 130is seen at the junction of the left L5 transverse process 110 with theleft superior articular process 120, and this complex forms the FPTcomplex 135 against which the Facet Base portion of the Facet Anchor isbrought.

DETAILED DESCRIPTIONS OF THE DRAWINGS DEMONSTRATING THE INVENTION

Referring now to the following drawings in which like numerals representsimilar or identical elements throughout the several views, andreferring particularly to FIG. 1, in which there is a frontal ortransaxial perspective view demonstrating the L4-L5 motion segment ontowhich a Spinofacet Stabilizer 1 has been secured. It should be notedthat throughout the drawings in this disclosure, the L4-L5 motionsegment is used for a representative motion segment for demonstrativepurposes; however, in fact this could represent any motion segmentthroughout the spine from T2-T3 to L4-L5. Facet Anchors 2 have beenapplied bilaterally, as is anticipated will be the case in the vastmajority of instances. The three components of the Stabilizer device 1are the Facet Anchoring Elements 2, which have been applied against theFPT complexes [stippled areas] of L5; the Spinous Anchoring Element 3,which has been applied to the spinous process of L4 in this view, and iscomprised of the left 15 and right 16 cranial quadrants; and theConnecting Elements 4. In this preferred embodiment illustrated here,the Connecting Elements 4 represent the coupling of the couplingextensions 12 of the Spinous Anchors 3 as they are reversibly coupledwith the coupling modulator 13 on the coupling extensions 11 of theFacet Anchors. The Facet Anchors 2 are seen comprised of a Facet Bases5, which are brought against the FPT complexes, and the TransverseProcess

Claws 6, which are brought against the junction of the transverseprocesses 109, 110 with the lateral aspects of the pedicles 123, 124.This point 14 is referred to in this disclosure are TP/Ped complex.Anatomic landmarks in this image also include the L5 vertebral body 102.It can be seen that the Facet Anchors 2 extend dorsally over the left115 and right 116 facet joints, hence stabilizing them.

The stabilization established by the invention is further appreciated inFIG. 2, in which a right lateral view of an L4-L5 motion segment thathas been stabilized with the Spinofacet Stabilizer, the TransverseProcess Claws 6 are seen relating to the cranial aspect of the right L5transverse process 110. The curvilinear leading end 7 of the TransverseProcess Claw 6 is seen having been brought against the target bonysurface area which is the transverse process I lateral pedicle junction14. The shaft 8 is seen extending from the leading end 7 to the trailingend 9 of the Transverse Process Claw 6. The trailing end 9 couples withthe cranial aspect of the Facet Base 5, which is in turn secured againstthe right L5 FPT complex (not seen in this projection) thusincorporating the L5 vertebra 102 into the construct created by theSpinofacet Stabilizer 1. The trailing end of the coupling extension ofthe Facet Anchor 11 is coupled with the Coupling Modulator 13, which isin turn coupled with the leading end of the coupling extension of theSpinous Anchor 12; the Spinous Anchor 3 is secured to the spinousprocess of L4 103, thus completing the construct. In this perspective,the Spinous Anchor can be seen as comprised of the right Cranial SpinousQuadrant 16 and the right Caudal Spinous Quadrant 17 which areadjustably connected by the right Lateral Spinous Coupler.

FIG. 3 allows for a greater understanding of the components of theSpinofacet Stabilizer 1 by providing a posterior view. Centrally, theSpinous Anchor 3 can be seen as composed of 4 elements which areadjustably assembled together to form an ovoid ring which can be tightlysecured against the spinous process. These include the left 15 and right16 cranial spinous quadrants, as well as the left 17 and right 18 caudalspinous quadrants. As demonstrated in this and other images, each ofthese components is coupled with two other components of the SpinousAnchor in the fashion illustrated. The coupling mechanism which isanticipated as the preferred method is a ratcheting mechanism, but thatis not illustrated in this image; however, any method of adjustablecoupling is included within the spirit and scope of this invention. Itcan be seen that at the most cranial aspects of the Spinous Anchor, theleft 15 and right 16 cranial spinous quadrants are coupled by thecranial spinous coupler 19. The left cranial spinous quadrant 15 thenalso couples with the left caudal spinous quadrant 17 at the leftlateral spinous coupler 20; in a similar manner, the right cranialspinous quadrant 16 couples with the right caudal spinous quadrant 18through the right lateral spinous coupler 21. Finally, the caudalspinous coupler 22 couples the left 17 and right 18 caudal spinousquadrants. Providing the Spinous Anchor 3 with an adjustable coupling atall 4 points insures that the Anchor can be secured to the spinousprocess (not shown in this image) with adequate fixation so that thereis no movement, which would reduce the fixation of the invention as awhole. Arising from the left 17 and right 18 caudal spinous quadrantsare the left and right coupling extensions 12. Each of these thencouples with the coupling modulator 13 on their respective sides. In thepreferred embodiment, the coupling modulators 13 are coupled with thetrailing ends of the coupling extensions 11 of the Facet bases 5. TheFacet bases 5 are then coupled to the trailing end of the TP claws, aspreviously shown in FIG. 3. The transverse processes of L5 on the left109 and right 110 are also labeled for orientation of the reader.

An elevational view of the Spinofacet Stabilizer as seen from the rightside allows FIG. 4 to demonstrate the structure of the invention in itsentirety. The midline Spinous Anchor 3 is adjustable in both thecraniocaudal and mediolateral axes, as demonstrated by the arrows, owingto the adjustable nature of the coupling of its component elements, theleft and right Cranial Spinous Quadrants 15, 16 as well as the left andright Caudal Spinous Quadrants 17 and 18. As demonstrated in otherviews, this assures a secure fit onto the spinous process. The CranialQuadrants are adjustably coupled by the Cranial Spinous Coupler 19. Theleft Cranial and Caudal Quadrants 15, 17 are coupled by the Left LateralSpinous Coupler 20, and the right quadrants 16, 18 are similarly coupledby the Right Lateral Spinous Coupler 21. It then becomes apparent thatthe caudal quadrants are coupled by the Caudal Spinous Coupler 22. Itcan be further seen that the Coupling Extensions 12 of the SpinousAnchors 3 couple with the Coupling Modulators 13, which in turn coupleswith the Coupling Extension 11 of the Facet Anchors 2. Morespecifically, the Coupling Extensions 11 of the Facet Anchors 2 are thencontinuous with the Facet Bases 5, the leading ends 29 which have beenbrought against the FPT complexes to stabilize the facet joints andallow the Spinofacet Stabilizer 1 to either compress or distract thetarget motion segment. The cranial aspects 10 of the Facet Bases 5couple with the Transverse Process Claws 6. This mechanism fixes thedevice against the posterior aspect of the target vertebra, thusstabilizing the construct.

In order to understand how the invention can result in eitherdistraction or compression of the target motion segment, FIG. 5 shows aright-sided view of the invention, demonstrating the Spinous Anchor 3securing the upper vertebra of the target motion segment while the FacetAnchor 2 is secured to the lower vertebra. The arrows demonstrate howthe Coupling Extension 12 of the Spinous Anchor 3 can be inserted intothe Coupling Modulator 13 and then the two anchoring elements can bemoved closer together to result in compression, or pulled further apartresulting in distraction, in accordance with that action deemednecessary by the surgeon. The other structures seen in this view are theright Cranial and Caudal Spinous Quadrants 16, 18 the right lateralcoupler 21. It is to be recalled that the Coupling Modulator 13 may beirreversibly coupled to either the Facet Coupling Extension 11 or theSpinous Coupling Extension 12.

Demonstrating how the Spinous Anchor securely attaches against thesurfaces of the spinous process, a top view of a disarticulated SpinousAnchor is provided in FIG. 6. This shows a preferred embodiment of 4components, specifically the left 15 and right 16 cranial quadrants andthe left 17 and right 18 caudal quadrants. These are coupled by theCranial Spinous Coupler 19, the Left and Right Lateral Couplers 20, 21and the Caudal Coupler 22. It is noted that various configurations ofthe coupling mechanism are portrayed herein, and it is known that otheriterations could be identified and are keeping within the spirit andscope of the invention.

FIG. 7 is an elevational exploded view of the Facet Anchor 2. It can beseen that this component is comprised of two elements, the Facet Base 5and the Transverse Process (TP) Claw 6. These two elements are coupledby the insertion of the coupling extension 26 of the trailing end 9 ofthe TP Claw into the insertion aperture 28 of the cranial side 10 of theFacet Base 5. This insertion is provided with a ratcheting mechanism orsome other adjustable mechanism such that the Transverse Process Claw 6can be rotated from the lateral to the medial perspective, and in thisfashion achieve a secure locked fitting against target bony area. Thisis further important as this ratcheting mechanism will also provide amore secure fit of the Facet Anchor against the bone. The Facet Base 5,in turn, is provided with a leading end 29, a central portion 30, and atrailing end 31. The leading end is brought securely against the FTPcomplex, to maximize the grasp of the Facet Anchor. Also noted is theCoupling Extension 11 arising from the Trailing End 31 of the Facet Base5. The trailing most end 32 of the Coupling Extension 11 is providedwith a roughened surface, which when interfacing with the interior 27 ofthe Coupling Modulator results in a cold weld.

FIG. 8 further demonstrates the Facet Base 5. The leading end 29 isconfigured to achieve maximum apposition against the target bonysurfaces, which ultimately results in greater efficiency of theinvention. The Coupling Aperture 28 accepts the Coupling Extension ofthe Transverse Process Claw (not Shown); the interface therein resultsin the rotation of the Transverse Process Claw into acceptable position.Also shown here is the Central portion or Body 30 of the Facet Base 5,as well as the Trailing End 31, and the Coupling Extension 11. Again,the Trailing most end 32 of the Coupling Extension 11 is noted to beroughened in order to be secured into a cold weld.

FIG. 9 shows the Facet Anchor 2 in position as demonstrated in atransaxial perspective of a representative facet joint, in this case theL4-L5 right sided facet joint.

The bony landmarks include the lateralmost aspect of the right L4 lamina112, as it sweeps into and becomes the right L4 inferior articularprocess 118, and articulates through the right L4-5 facet joint proper116 with the right L5 superior articular process 120. Also seen are theright L5 pedicle 124 and the right L5 transverse process 110. Theleading end 7 of the Transverse Process Claw 6 as it is compressedagainst the TP/Ped complex 14. The shaft of the Transverse Processpasses over the cranial aspect of the transverse process 110 to couplewith the Cranial aspect 10 of the Facet Base 5. The Trailing End 31 ofthe Facet Base 5 is continuous with and monolithic with the CouplingExtension. As this is disposed over the Facet Joint 116, it stabilizesthe joint.

FIG. 10 is a right lateral perspective of the L4-5 motion segment, withthe L4-5 disc space 100, the L4 101, the L5 102 and the respectivespinous processes 103, 104. This image demonstrates the process ofimplanting the invention. In the first step, after a skin incision ismade (horizontal dotted line), and the Spinous Anchor insertion device33 is used to dispose the Spinous Anchor 3 through the incision. It isnoted that the initial incision is made with the Spinous Anchororthogonal to its final orientation. Once it has been positioned betweenthe L4 spinous process 103 and the L5 spinous process 104, the device isdeployed, and the Spinous Anchor is rotated into its final orientationso that it can be compressed until the correct size is achieved.

Once the Spinous Anchor is in place, one method for completing theimplantation of the invention is to utilize the method described in FIG.11A/B. In FIG. 11A, after implantation of the Spinous Anchor 3 on the L4spinous process 103, an insertion cannula 35 is disposed through a tractand positioned against the FPT complex. The Facet Anchor is passedthrough the cannula, and the Facet Anchor is applied to the target bonysurfaces. At that point, as demonstrated in FIG. 11B, a connecting rodelement 4 is disposed through a submuscular tract until it is coupledwith the Facet Anchor 2, and subsequently coupled with the SpinousAnchor 3. The right L4 140 and L5 141 are seen escaping from the spinalcanal.

This process is again illuminated in FIGS. 12AIB. These images show aposterior view of the implantation procedure discussed in FIGS. 11A/Babove. Again, the Spinous Anchor is initially implanted and secured,followed by placement of an implantation cannula 35 over the facetjoint. The Facet Anchor 2 is then secured into place, and the Connectingrod 4 is passed between the two anchoring elements and secured to both.

FIG. 13 demonstrates the posterior view of a multi-level construct, inthis case spanning from L3 to S1. At each level, the Spinous Anchor 3 ispresent, as well as the connecting element 4, and the Facet Anchor 5.Such a construct can be achieved with the use of either multipleindependent Spinofacet Stabilizers, or a bridging element 40 can beintroduced. In this construct, L5-S1 requires special variations,including the use of S1 sickles 41.

FIG. 14 shows the posterior view of an alternative embodiment, in whichthe Spinous Process is not incorporated into the stabilization scheme.

FIG. 15 achieves stabilization at L5-S1. It is recognized that there isno transverse process present at S1, and a greatly reduced so thatachieving stabilization requires alternative embodiments. In thisembodiment, a Spinous Anchor 3 is placed at L5, as are connectingelements 4. A bracket/block 37 is passed over the sacral ala along itsedge, and after achieving a reasonably secure fit this is coupled withthe Connecting Element 4.

FIG. 16 demonstrates a variation of the theme at S1, in which asickle-shaped bracket is passed along the caudal edge of the S1 superiorarticular process 143, and after connecting this to the Spinous Anchor,a secure stabilization is achieved.

In FIG. 18 we see the facet base 45 includes a facet clamp portion 46and an adjustable locking claw 47. The facet clamp portion and thelocking clamp portion cooperate with each other to grip the facetprocess. The base also includes a socket 48 into which a rod-likeextender 49 with a ball end 50 can be inserted through to form alockable joint. The extender can be extended and rotated to the spinousanchor segment 44 in this embodiment.

FIG. 17 shows that the facet base anchors can be deployed in twodifferent orientations allowing for a flexibility of use in application.The facet anchor bases can employ one clamp and a screw in an alternateembodiment to fix to the facet process. The facet can also be angled 53to improve fit.

In another embodiment of the invention FIG. 20 the spinous anchorcomprises two separate portions each of which has a body portion 54, anextender acceptor 55 to accept the extender from the facet base; a bodywhich includes a clamp end 56, 57 and a conduit that transport a fixablyadjustable rod 58 with a clamping means 59 on a far end of said rod,opposed from said body and said clamp.

The iterations and embodiments of the invention are presented in theirgeneral format, but it is recognized that those skilled in the art mayevolve and demonstrate other embodiments which are obvious when viewedin the face of these disclosures; clearly, all similar embodiments anditerations are within the spirit and scope of the invention.

What is claimed is:
 1. An apparatus for diagnosing pain in human spinescomprising a vertebrae anchoring apparatus comprising: a facet anchorbase comprising a transverse process claw, a shaft connects a leadingend of said transverse process claw to a trailing end; the trailing endbeing coupled to a facet base in such a fashion that said transverseprocess claw can be brought against a target bony facet surface.
 2. Theapparatus of claim 1 further comprising a spinous anchoring base wheresaid spinous base includes a left cranial spinous quarter; a rightcranial spinous quarter, a left caudal spinous quarter and a rightcaudal spinous quarter wherein said quarters are adjustablyassemble-able together to form an ovoid ring which can be tightlysecured against a spinous process.
 3. The apparatus of claim 2 whereinsaid facet anchor further comprises a facet coupling extension; and saidspinous anchor further includes a spinous coupling extension.
 4. Theapparatus of claim 3 where said facet anchor further comprises acoupling peg with a shaft interconnecting said transverse process clawand said facet base and where said shaft incudes means for fixing saidshafts position.
 5. The apparatus of claim 4 wherein said means forfixing is a series of corrugations.
 6. The apparatus of claim 5 whereinsaid facet coupling extension is couple-able with a coupling modulatorto said spinous coupling extension.
 7. The apparatus of claim 1 used toform a system for stabilizing in a predetermined fashion a plurality ofspinal joints.
 8. The apparatus of claim 7 wherein said system comprisesat least four facet anchors and one spinous anchor.
 9. The apparatus ofclaim 1 wherein there are at least three spinous anchor segments andwhere at least one of said elements is provided with an extensioncouple-able to another mechanical element.
 10. The apparatus of claim 9wherein a second spinous anchor segment is provided with an extensioncouple-able an extender.
 11. An apparatus for diagnosing pain in humanspines comprising a vertebrae anchoring apparatus comprising: a spinousanchoring base where said spinous base include a left cranial spinousquarter; a right cranial spinous quarter, a left caudal spinous quarterand a right caudal spinous quarter wherein said quarters are adjustablyassemble able together to form an ovoid ring which can be tightlysecured against a spinous process.
 12. The apparatus of claim 11 furthercomprising a spinous coupling extension.
 13. The apparatus of claim 12further comprising a second spinous anchoring base where said secondspinous base include a left cranial spinous quarter; a right cranialspinous quarter, a left caudal spinous quarter and a right caudalspinous quarter wherein said quarters are adjustably assemble abletogether to form an ovoid ring which can be tightly secured against aspinous process, and said second spinous anchoring base furthercomprises coupling extension couple-able with a coupling modulator tosaid first spinous coupling extension.
 14. An apparatus for stabilizingvertebrae of the human spine comprising a spinous anchoring base wheresaid spinous base include a left cranial spinous quarter; a rightcranial spinous quarter, a left caudal spinous quarter and a rightcaudal spinous quarter wherein said quarters are adjustably assembleable together to form an ovoid ring which can be tightly secured againsta spinous process; an extendor; and a bracket block; wherein saidspinous anchor; said extendor and said bracket block are configured tostabilize the L5-S1 joint.